OIG: CMS Not Checking Data on Meaningful Use

WASHINGTON -- A government report slammed the Centers for Medicare and Medicaid Services (CMS) for not doing more to ensure incentives it pays for electronic health record (EHR) usage are going to those who deserve it.

CMS plans to pay hospitals and providers $6.6 billion between 2011 and 2016 for showing "meaningful use" of EHRs in their practice. However, the agency hasn't implemented strong pre-payment safeguards to ensure outgoing payments go to providers who fully meet the requirements, the Office of Inspector General (OIG) at the Department of Health and Human Services said this week.

CMS had planned to audit selected physicians and hospitals after payment to assure self-reported meaningful use information is accurate. "At the time of our review, CMS had not yet completed any post-payment audits," the report stated.

In addition, all self-reported information was approved for meaningful use payments as of December 2011, it said.

The OIG reviewed CMS' oversight of the certification process for meaningful use bonuses. It did not assess whether or not practitioners or hospitals receiving payments were actually eligible for them.

To qualify for a payment, providers and hospitals must show the meaningful-use-certified EHR technology as defined in federal regulations and use measures. Metrics include e-prescribing, computerized order entry, and the exchange of key clinical information, among others.

Starting in May 2011, physicians can receive up to $44,000 in incentive payments over the duration of the program, which was created under the 2009 economic stimulus bill. As of September, CMS has paid about $4 billion to 82,535 professionals and more than 1,400 hospitals, the OIG said.

Even if there is an audit, CMS can't verify all self-reported information because it doesn't require technology to be capable of producing reports for all meaningful-use measures, the OIG found. Also, reports from EHRs may produce inaccurate information.

If there is an on-site audit, providers may not have all the data needed to verify self-reported information. CMS hasn't provided guidance on what is needed to support documentation.

Providers must retain documents supporting their self-reported meaningful use information for 6 years, the OIG said. Partially meeting meaningful use requirements doesn't qualify for incentive payments.

The OIG recommended CMS review supporting documentation from selected providers before issuing a payment. "CMS could feasibly conduct risk analyses to select a subset of professionals and hospitals from which to request supporting documentation," the report stated.

However, CMS rejected this idea, the OIG said, saying it could delay incentive payments and increase the burden on practitioners and hospitals.

"CMS is currently implementing a batch reporting mechanism that will enable a provider to submit a batch file of the attestation information generated by their EHR for all of a group's individual eligible professionals," acting CMS Administrator MarilynTavenner wrote to the OIG. "We believe this new functionality will further enhance the accuracy of the data submitted by providers."

CMS did agree with a second OIG recommendation that called for the issuance of guidance with specific examples of information that providers should maintain to support their compliance.

The OIG is conducting audits of Medicare and Medicaid EHR incentive payments. "These audits will verify the accuracy of professionals' and hospitals' self-reported meaningful use information, as well as eligibility and payment amounts," the report said.

The OIG also reviewed last July the oversight of 13 states and their EHR incentive programs, finding all planned to verify compliance with at least half of eligibility requirements before making payments.

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